Exploring the reasons behind the low focus on upper limb rehabilitation in the early stages after a stroke : A qualitative study

Wodu, Chioma and Sweeney, Gillian and Kerr, Andy (2024) Exploring the reasons behind the low focus on upper limb rehabilitation in the early stages after a stroke : A qualitative study. Journal of Hand Therapy. ISSN 0894-1130 (In Press)

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Abstract

Background: One aspect that is often impaired in people living with stroke is the motor function of the upper limb. Purpose: To explore the reasons behind the low focus on upper limb rehabilitation after stroke and to understand the views of Rehabilitation Professionals on the use of upper limb rehabilitation technologies for self-management of stroke. Study Design: A qualitative descriptive design that employs a one-on-one semi-structured interview method. Methods: A total of nine Rehabilitation Professionals (RPs) (physiotherapist n=6 and occupational therapist n=3), recruited from the distribution list of the Scottish Stroke Allied Health Professional Forum (SSAHPF) participated. Interviews were held in person or via teleconferencing, recorded, and recordings transcribed verbatim. Interview questions were approved by the author’s institutional ethics committee. All transcribed data were analyzed using thematic analysis, with an inductive approach. Results: The average length of practice years of the RPs in this study was 24.7±9.8 with 16.44±9.19 experience in stroke/neurological rehabilitation. The views gathered from all nine (9/9) of the RPs point to a low focus on upper limb rehabilitation for people living with stroke in the early stages after stroke. In an inpatient setting this was attributed to the rehabilitation goals/ priorities (of people living with stroke, RPs, and/or hospital’s rehabilitation/stroke units), inadequate resources, and the inability of the RPs to deal with the high incidence of stroke. After discharge from the hospital, it was attributed to the cost of securing private rehabilitation and poor knowledge of rehabilitation technologies that can support self-rehabilitation. The cost, design, and inadequacy of evidence on the effectiveness of some available upper limb rehabilitation technologies are reasons that could make it difficult for RPs to promote the use of rehabilitation technologies which could also contribute to the poor knowledge of their availability. Conclusion: There is a low focus on upper limb rehabilitation after a stroke, particularly during the early stages. This has been associated with the pursuit of early discharge which appears to attach higher priority to lower limb rehabilitation during goal setting. In addition to the inadequate resources and a lack of capacity to deal with the high incidence of stroke.

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